What is the pelvic floor?
The pelvic floor is also sometimes called “the hammock” for the abdominal organs, such as the bladder, the intestines, and the uterus. It consists of a number of muscles that close off the bottom of the pelvis, thereby supporting the bladder, intestines, and uterus. It also allows you to hold in urine, stool, and gas, and enables you to urinate and have a bowel movement. In addition, it plays a role in arousal and orgasm during sex.
The Pelvic Floor During Pregnancy
During pregnancy, pregnancy hormones cause the muscles and tendons around the pelvis to become more supple and flexible. This makes it easier for the baby to pass through the pelvis during delivery. As the uterus and the baby grow, the pressure on the pelvic floor increases steadily. This causes the tissue to stretch significantly. Sometimes small tears develop in the pelvic floor, or an episiotomy is performed during delivery that requires stitches afterward. This takes time to heal. Afterward, it is usually not possible to put full weight on the pelvic floor right away.
The Pelvic Floor After Childbirth and Recovery
It takes at least 9 months for the pelvic floor and pelvis to recover after childbirth. Although the pelvic floor has not been stretched during a cesarean section, it still needs to recover from the pregnancy.
First 10 days:
During the first few days, the area around the anus and vagina may feel sore or tender. If stitches were needed, they may also feel tight or painful. You may experience pain when having a bowel movement or urinating.
Recommendation:
- Get out of bed only to take care of yourself and your baby; try to keep climbing stairs to a minimum
- During daily activities, such as “turning over in bed, sitting up, and walking,” be sure to breathe calmly into your abdomen; don’t hold your breath
- Keep your stools soft by drinking plenty of fluids and eating a high-fiber diet. If your stools remain hard, discuss this with your midwife or family doctor.
- Take your time when you urinate, sit up straight, and empty your bladder completely without straining.
Toilet Tips:
- Sit upright when urinating, and when having a bowel movement, sit back slightly, possibly with a stool under your feet
Take your time, don't strain, and completely empty your bladder and bowels.
10 days to 6 weeks:
From now on, the pelvis and pelvic floor will begin to heal, and sensation will gradually return to the pelvic floor muscles. One month after giving birth, the pelvic floor muscles will have regained 20% of their normal strength.
Recommendation:
- When lifting and carrying the baby, consciously tighten your pelvic floor muscles
- Do not lift more than the baby's weight
- Tighten your abdominal muscles when changing positions, such as standing up, sitting down, or climbing stairs
- Build up your fitness gradually by biking or walking
- Avoid standing for long periods or doing strenuous household chores, such as mopping and vacuuming
6 weeks to 6 months:
The pelvic floor muscles and tendons have regained 50% of their normal strength.
Recommendation:
- If you need to carry or lift something, hold it close to your body or carry it in a backpack
- Try to avoid lifting a Maxi-Cosi for long periods of time, and use a stroller for longer distances instead
6 to 9 months:
Your pelvic floor muscles and tendons have now regained 75% of their normal strength. If you have no symptoms, you can start running.
Recommendation:
- When doing strength training, you start with a light weight and 20–30 repetitions
- Build up your running gradually and start by jogging at a relaxed pace in intervals. Only then should you increase your pace.
Possible symptoms related to the pelvis and pelvic floor
It is not a given that every woman will make a full recovery after giving birth. For example, there are a number of symptoms that may persist after childbirth:
- Urine leakage when coughing, sneezing, laughing, or jumping
- Difficulty holding in urine
- Difficulty holding in stool
- Difficulty urinating
- Having trouble pooping
- A heavy, pressing sensation in the lower abdomen or a feeling of fullness in the vagina
- Pain During Intercourse
- Pain in the pelvis, lower back, or tailbone
If you recognize any of these symptoms in yourself, don’t wait too long—make an appointment with a (pelvic) physical therapist.
We, as (pelvic) physical therapists, recommend that every woman complete this questionnaire (www.bekkenbodemcheck.nl) 6 weeks after giving birth. This questionnaire helps determine whether someone is experiencing symptoms in and around the pelvis or is at risk of developing them later. Based on the results, appropriate advice is provided.
Jana Hug, General Physical Therapist and ZwangerFit Instructor, BIG 99924044304
Nicole Terwindt, Pelvic Physical Therapist, BIG 29035169404
